Prognosis of surgery combined with different adjuvant therapies in esophageal cancer treatment: a network meta-analysis

Abstract

This network meta-analysis was conducted to assess whether the efficacy of surgery with adjuvant therapies, including radiotherapy (RT+S), chemotherapy (CT+S), and chemoradiotherapy (CRT+S) have better performance in esophageal cancer treatment and management. PubMed and EMBASE were used to search for relevant trials. Both conventional pair-wise and network meta-analyses were carried out. The surface under the cumulative ranking curve (SUCRA) was used to rank interventions based on the efficacy of the treatment method. As for 3-year overall survival (OS), CRT+S showed the highest efficacy (CRT+S vs.

Surgery: HR=0.81, 95% CrI =0.73-0.90; CRT+S vs. CT+S: HR=0.82, 95% CrI =0.70-0.95; CRT+S vs. RT+S: HR=0.77, 95% CrI =0.62-0.95). For disease-free survival, CRT+S showed efficacy over CT+S ((HR =0.70, 95% CrI =0. 59-0.83). In conclusion, CRT+S showed a better performance for survival outcomes and ranks best among all therapies. The results of our study can provide guidance for medical decisions and treatment options that may help clinical practitioners improve the efficacy of EC treatment.

Keywords: adjuvant therapies; chemotherapy; esophageal cancer; radiotherapy; surgery.

Figure 1. Flow chart

There are 42 studies included at last.

Figure 2. Network of randomized controlled trials comparing different treatments of EC

Treatment: CRT+S-chemo-radiotherapy plus surgery, CT+S-chemotherapy plus surgery, RT+S-radiotherapy plus surgery. Numbers above lines represent direct comparisons between two treatments. Numbers above dots represent total size of the treatment.

Figure 3. Hazard ratios (95% credential intervals) of overall survival in 3 years and 5 years for network comparison of EC treatments

Figure 4. Hazard ratios (95% credential intervals) of disease-free survival for network comparison of EC treatments

Figure 5. Node Splitting results according to type of treatments for recurrence

Figure 6. Heat plot for EC treatments

The area of the gray squares displays the contribution of the direct estimate in design d (shown in the column) to the network estimate in design d (shown in the row). The colors are associated with the change in inconsistency between direct and indirect evidence (shown in the row) after detaching the effect (shown in the column). Blue colors indicate an increase and warm colors indicate a decrease (the stronger the intensity of the color, the stronger the change).